Comparative Analysis of Functional and Radiological Outcomes in Comminuted Distal Radius Fractures: Variable Angle Locking Plate vs External Fixation

Background: Distal radius fractures are among the most common orthopedic injuries, with treatment outcomes influenced by patient age, bone quality, and fracture complexity.Optimal surgical management for comminuted distal radius fractures remains controversial, particularly between variable angle locking plates (VALP) and external fixation (ExFix).Objective: To compare the functional and radiological outcomes of comminuted distal radius fractures treated with VALP vs ExFix.Materials and methods: A prospective study was conducted at Kamineni Academy of Medical Sciences and Research Centre from September 2022 to June 2024, involving 60 patients with Mller AO type C distal radius fractures.Patients were randomized into two groups-group A (n = 30) underwent VALP fixation, and group B (n = 30) underwent ExFix.Functional outcomes were assessed using the Modified Green O'Brien scoring system, and radiological outcomes were evaluated via serial radiographs measuring radial length (RL), inclination, palmar tilt (PT), and ulnar variance (UV).Results: Group A demonstrated superior pain relief, range of motion (ROM), and earlier functional recovery.Radiologically, VALP better restored RL and inclination.Complications such as stiffness and pin site infections were more frequent in the ExFix group.Statistical analysis showed significant improvement in final Green O'Brien scores in the VALP group (p < 0.05).Conclusion: VALP offers better anatomical restoration and functional outcomes compared to ExFix in the management of comminuted distal radius fractures.While ExFix remains useful in highly comminuted cases or where plating is not feasible, VALP should be preferred when surgical expertise is available.